When a new year starts, many people with lung disease who take expensive medications brace themselves for high copays until they hit their out-of-pocket maximum, often reaching thousands of dollars. But if you have Medicare coverage, 2025 could be different.
Medicare Part D covers prescription drugs for people on Medicare, including seniors and people with disabilities. In 2025, for the first time, Medicare caps the cost of prescription drugs for Medicare patients at $2,000 per year. This new policy, which was part of the Inflation Reduction Act (IRA), protects seniors from catastrophic prescription drug costs. This is especially important for people who are on high-cost, maintenance drugs, including patients with chronic lung disease, like COPD.
Also beginning in 2025, patients have the opportunity to enroll in the Medicare Prescription Payment Plan (MPPP). This plan allows Medicare beneficiaries to pay their out-of-pocket prescription drug costs in monthly installments rather than paying the very high costs in the first month or two of the year. Medicare beneficiaries have to opt-in to the program and can do that at any time throughout the year. If you switch Medicare Part D plans, you would need to re-enroll in the MPPP.
These new programs and policies are essential for the 35 million people living with lung disease nationwide. One such patient, Bonnie, was diagnosed with a genetic lung condition that causes familial emphysema. She is doing well after a lung transplant, and relieved to have affordable Medicare coverage for her anti-rejection medication.
Bonnie has benefited from the new policies, which limited out-of-pocket costs and meant her anti-rejection medications were fully covered. Without this coverage, Bonnie would have faced high costs for prescriptions.
She hopes her coverage doesn’t go away. “What would I do if I didn’t have coverage?” she asks. “I have to be on immunosuppressants for the rest of my life – and they aren’t cheap.”
Another patient, Donna, has also benefited from the new cap on Medicare Part D prescription drugs. Living with multiple chronic conditions, she has long faced high prescription drug costs—typically exceeding $7,200 per year.
In 2024, Donna’s husband’s health deteriorated rapidly, and he passed away within six months after a brief battle with cancer. In his final days, one of his greatest concerns was ensuring that Donna could manage her healthcare needs and the burden of prescription drug costs. When he learned about the change in Medicare Part D prescription costs, he felt a sense of relief, grateful for one less financial worry for his family. He deeply appreciated the recognition and support provided to seniors navigating healthcare expenses and prescription medications.
In 2025, thanks to the new $2,000 out-of-pocket cap on Medicare Part D prescription drugs, Donna’s medication costs have become much more manageable. This change has provided her with financial relief and eased some of her worries as she transitions into this new chapter of her life.
The Inflation Reduction Act (IRA) was signed into law in 2022 and has a number of policies that benefit lung health. In addition to creating the $2,000 cap on prescription drugs and the MPPP, the law ensures that Medicare Part D covers immunizations without cost-sharing and makes investments in clean air and climate.
Patients can enroll in the MPPP at anytime during the year, so if patients missed the opportunity to enroll during Medicare Open Enrollment, they can do so now. And if a patient starts a new medication in March or April with a high out-of-pocket cost, they could enroll in the MPPP to spread that cost over the 9 or 10 remaining months of the year, rather than pay a higher cost all at once.
In addition to these new policies, Medicare helps low-income seniors afford their Part D prescription drugs through a program called the Low-Income Subsidy (LIS) program or Extra Help. Individuals eligible for the LIS program are able to participate in the MPPP, but LIS enrollment will provide more help with costs than the MPPP. Under the LIS program, individuals have $0 premiums and low-cost, fixed co-payments for covered prescription drugs. Learn more about extra help and apply here.
These policies, including the $2,000 per year cap on Medicare Part D prescription drugs and the MPPP, help lung disease patients access the treatment they need. For more information, please visit: Lung.org/medicare
Blog last updated: April 7, 2025
